Tamoxifen has been associated with seven times the risk of thrombosis of the veins or arteries (J of Clin Onc, 1991; 9:286-94.) It has also been linked with toxic effects on the eyes, (BMJ, 1992; 304:495-96), with an estimated incidence of 6.3 per cent, and may cause liver damage, including cancer.

According to research quoted in allergist and WDDTY panellist Dr John Mansfield's The Migraine Revolution (Thorsons), food allergy is the main single cause of migraine and accounts for between 80-90 per cent of the problem.

The most comprehensive, double blind controlled trial of food allergy and migraine to date, conducted by the Department of Neurology and Immunology at the Hospital for Sick Children (Great Ormond Street) and the Institute of Child Health, found that 93 per cent of 88 children with severe, frequent migraine recovered once the foods they were allergic to had been detected and eliminated from their diet (The Lancet, October 15, 1983).

Dr Mansfield also says that, contrary to the popular belief that foodstuffs such as cheese, chocolate and red wine are most likely to trigger migraine, wheat, corn, milk, sugars and oranges are the biggest offenders.

In fact, WDDTY panel member Dr Melvyn R. Werbach, assistant clinical professor at UCLA's School of Medicine, has found evidence both for and against the link between chocolate and migraine. In one controlled study, 36 patients who attributed their migraines to chocolate were given either phenylethylamine or placebo. Phenylethylamine is a vasoactive amine capable of changing the size of blood vessels, which is found in chocolate. All 18 patients in the phenylethylamine group reported attacks 12 hours after taking phenylethylamine, compared to six of the 18 who took the placebo (Nature 1975, 257:256).

In another double blind study, 13 out of 80 patients had a migraine attack after eating chocolate, but in only two could these reactions be reproduced with consistency (J Neurol Neurosurg Psychiatry, 1974; 37:445). And in another double blind study, 100 patients showed no evidence of an increase in frequency of headaches after taking tyramine (another vasoactive amine found in chocolate), phenylethylamine or chocolate, despite their conviction that chocolate would cause them to develop a headache (The Lancet 1974; 2:7885).

Dietary copper may trigger migraine. Copper is involved in the metabolism of the vasoactive amines, and Dr Werbach believes that this metabolic process may be abnormal in migraine sufferers. Foods with a high copper content include chocolate, nuts, shellfish and wheatgerm. Citrus fruits increase intestinal copper absorption, and monosodium glutamate (MSG) binds and transports it. Both citrus fruits and MSG have been linked with migraine.

Other studies suggest that supplementation with vitamin B6, magnesium, lithium and/or omega-3 fatty acids (fish oils) may help relieve migraine symptoms. In one double blind study, 15 patients who had severe migraine which hadn't responded to medication found they were having fewer headaches, which were not as intense, after taking supplements of fish oils EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) (Am J Clin Nutr 1986; 43:710). Cod liver oil is not recommended due to its high vitamin A content.

In another double blind study, six chronic sufferers with severe, very frequent migraine were given 20mg of fish oil or placebo daily for two six week treatment phases. Five patients experienced significant relief, of both frequency and intensity of headaches (Am J Clin Nutr, 1985; 41:874a).

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